Brainwave control of a wearable robotic arm for rehabilitation and neurophysiological study in Cervical Spine Injury

Progress
100%
Period
01/04/14 to 31/03/15
25.000

CSI:Brainwave project’s full title is “Brainwave control of a wearable robotic arm for rehabilitation and neurophysiological study in Cervical Spine Injury” .

It constitutes a multidisciplinary neurophysiological project, developed by the Biomedical Electronics Robotics & Devices (BERD) research group, which is housed in the Medical Physics Laboratory of Aristotle University of Thessaloniki, Greece. The project is supported by two Neurosurgical Departments and has received funding by the 2013 “Mario Boni” Research Grant, awarded by the Cervical Spine Research Society – European Section (CSRS-ES).

The project meets critical acclaim wherever is presented. Recently the Hellenic Spine Society (http://eess.gr) awarded the presentation of CSI:Brainwave project with the 2016 “Vicky Zachariou” award during the 10th Hellenic Spine Congress & Joint Meeting with French and Turkish Spine Society, that took place on 26-29 October at the Makedonia Palace Hotel in Thessaloniki (http://synthesispco.com/spine2016). For more info, please read the relevant piece of news (http://medphys.med.auth.gr/content/distinction-csi-brainwave-research-project-medical-physics-lab-auth).

This project started on April 2014 and, while originally was planned to run for three years (expected completion early 2017), it has been extended and currently recruits patients (as of December 2016). The project is registered with ClinicalTrials.gov under NCT02443558 (https://clinicaltrials.gov/ct2/show/study/NCT02443558).

The CSI:Brainwave project involves:

  • A clinical study for rehabilitation of patients with Cervical Spinal Cord Injury (CSCI), using a Brain-Computer Interface (BCI) controlled wearable robotic arm.
  • A comparative neurophysiological analysis of cortical activation, connectivity and plasticity in patients with CSCI undergoing motor imagery (MI) practice.

Primary objectives:

  • To develop, test and optimize a mountable robotic arm controlled with wireless BCI.
  • To develop and validate self-paced neuro-rehabilitation protocols for patients with CSCI.
  • To identify and study the neurophysiological functionality and alteration of cortical activity in acute and chronic CSCI.

The CSI:Brainwave project aims at allowing patients suffering from tetraplegia due to CSCI to perform brainwave modulation, practicing Visual & Kinesthetic Motor Imagery (VMI  & KMI) and offering neurofeedback with the form of control of a 8-degree-of-freedom bimanual robot.

Eventually, we aim to design the robotic arms as to mount on the patient’s plegic arm and allow the patient to directly control it using a BCI module. The project aims at demonstrating the added value of neurofeedback for rehabilitation and/or motor restoration of CSCI patients.

The project makes use of the “MERCURY” robot, which consists of a bimanual, fully digital, 6-degrees-of-freedom robotic arms apparatus, which was developed under CSI:Brainwave to reach version 2.0. The robot was initially constructed and developed by members of the BERD group. Please see the MEDIA section at the end of this page.

Under the auspices of the project, the research group gained permission to translate and validate the Spinal Cord Independence Measure in the greek language to be used for patient evaluation. More relevant evaluation tools are also involved and the research team has asked for official permissions for their translation, as well.

Background & Methodology

In terms of brain networks we aim to: 1) identify how reorganization can be correlated according to neurological condition, 2) identify adaptive and maladaptive changes in connectivity and 3) produce imaging “biomarkers” of neurological condition & improvement. We also aim to 4) measure the impact of brain-computer interface (BCI) training in brain networks following SCI. Moreover the project also aims at 5) developing and validating a non-invasive network-based BCI for rehabilitation and motor restoration of SCI patients making use of the derived knowledge and BCI-controlled anthropomorphic robotic arms.

Spinal Cord Injury (SCI) causes alterations in brain organization and structure, including changes in brain connectivity (BC), such as abnormal alterations and pathological brain activations (Freund et al. 2013; Nardone et al. 2013). Those have been shown even during the early stages of SCI and they correlate with the degree of neurological impairment (Nardone et al. 2013). fMRI studies within the first month post-injury depicted altered spontaneous resting-state brain activation in almost all cortical and sub-cortical sensorimotor areas and at mean two months post-injury showed structural changes and network alterations (Hou et al. 2014a; Hou et al. 2014b; Hou et al. 2016). Decreased inter-hemispheric resting-state functional connectivity (FC) and increased intra-hemispheric resting-state FC within the sensorimotor cortex, premotor area, supplementary motor area (SMA) and other nodes of the motor pathways have been calculated (Min et al 2015a; Min et al 2015b). Somatosensory networks showed decreased connectivity in SCI patients compared to healthy controls while predictors of good versus poor neurological recovery at 6 months post-injury has been theorized that can be deduced from such reorganization (Hou et al. 2014b). During chronic phases of complete SCI, the continued disruption of sensorimotor pathways causes reorganization of resting-state functional networks (Astolfi et al. 2007; Mattia et al. 2009).

These alterations have not been systematically investigated and are often not taken into consideration in neurophysiological experiments or rehabilitation practices, while the most important questions regard whether and when such reorganization is adaptive (and should be promoted) or maladaptive. In light of very recent research findings reported by Donati et al. (2016), that show that BCI use for neurorehabilitation by SCI patients promotes an initially unexpected plasticity-induced neurological recovery, research on brain network plasticity following SCI should be considered timely and of great importance to the field. While studies on the field have been published, we aim to be among the first to systematically produce classifiable results regarding reorganization that occurs after SCI and BCI training.

Eligible participants for the study include female & male healthy individuals and SCI patients. Inclusion criteria are: clinical diagnosis of SCI (evaluated by ASIA scores & Impairment Scale) or healthy participants (age and gender matched to SCI patients), sufficient documentation of the injury (recorded neurological examination and history, imaging of the injury by MRI or other means). Exclusion criteria are: other neurological hat has a possibility to significantly affect the neurological status of the participants (or) the ability to control a BCI (or) the neurophysiological recordings (such as traumatic brain injury, CNS tumors, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Parkinson's disease or refractory epilepsy), other grave medical condition that could affect the participation (or) the safety of the participants (such as cardiac deficiency, pulmonary deficiency, hearing and visual impairments that can affect the participant's understanding of the intervention and performance, illegal drug use or chronic alcoholism).

Estimated enrollment is 30 SCI patient participants. Participants are classified into four categories: a) Experimental: Complete Injury. Patients suffering from complete injury at the cervical spinal cord level (ASIA Impairment Scale A). b) Experimental: Incomplete Injury, patients suffering from incomplete injury at the cervical spinal cord level (ASIA Impairment Scale B,C,D,E). c) Active Comparator: Non-cervical injury, patients suffering from complete or incomplete injury of the spinal cord at a level other than the cervical (thoracic or lumbar). d) Active Comparator: Healthy participants, age and sex matched to those of the other arms. Assessment of neurological condition, as well as of alterations (or possible recovery) of function will be made with the ASIA scores and impairment scale, the greek translation of the Spinal Cord Independence Measure (g-SCIM-III) and where appropriate with the Walking Index for Spinal Cord Injury (WISCI). Functional status will be re-assessed at 6 months and 1 year after the intervention.

Participants, after initial interview and examination will also be subjected to a brain MRI scan (to be used as an individual model in subsequent brain networks analysis). The experimental procedure consists of two parts. During the first part, they will be performing Kinesthetic and Visual (while presented with relevant videos) Motor Imagery (MI) tasks of the upper extremities (both arms, 7 degrees-of-freedom) and a MI walking task, while under high-resolution (128channels) EEG recording. During the second part, they will be controlling the bimanual robot with the 14channel Emotiv EEG and the home-built BCI program. All neurophysiological recordings (both of 128channels and of 14channels) will be subjected to an offline brain network analysis (Athanasiou et al. 2016b). This will be performed in Matlab using appropriate toolboxes (brainstorm, EEGLAB, eConnectome) using the participants own individual brain model (extracted from base MRI scan). Connectivity algorithms used will also include time-adaptive techniques. Subject to sufficient funding, the experimental procedures and analysis will be repeated at the 1-year post-intervention period.

 

Project news

Distinction for CSI: Brainwave research project of the Medical Physics Lab of AUTH

Dec 05, 2016 / 0 Comments

Distinction for CSI:Brainwave research project of the Medical Physics Lab of AUTH

 

Project members

Faculty

Panagiotis Bamidis

Doctoral Research Students

Alkinoos Athanasiou

Panagiotis Kartsidis,

Visiting Faculty

Alexander Astaras

Aristidis Gogoussis

Anestis Kalfas

Manousos Klados

Nicolas Foroglou

Konstantinos Polyzoidis

Aristidis Prassas

Research Assistants

Giorgos Arfaras

Undergraduate students

Kyriaki R Kavazidi

Ioannis Xygonakis

 

Publications

Peer reviewed journals

2016

2013

  • Astaras A, Moustakas N, Athanasiou A, Gogoussis A (2013). Towards brain computer interface control of a 6-degree of freedom robotic arm using dry EEG electrodes. Advances in Human-Computer Interaction, 2013: 641074, 6 pages, https://dx.doi.org/10.1155/2013/641074

Conference contributions

2016

  • Athanasiou A, Klados MA, Astaras A, Foroglou N, Magras I, Bamidis PD (2016). State of the art and future prospects of nanotechnologies in the field of Brain-Computer Interfaces. In: Kyriacou E, Christofides S, Pattichis CS (eds.) IFMBE Proceedings, 57: 456-460, Spinger International Publishing Switzerland, https://dx.doi.org/ 10.1007/978-3-319-32703-7_89
  • Athanasiou A, Klados MA, Foroglou N, Kavazidi KR, Polyzoidis K, Bamidis PD (2016). Reorganization of brain networks after spinal cord injury: a qualitative synthesis of the literature. Frontiers in Human Neuroscience Conference Abstract: SAN2016 Meeting. https://dx.doi.org/10.3389/conf.fnhum.2016.220.00036
  • Athanasiou A, Foroglou N, Prassas A, Polyzoidis K, Bamidis PD PD (2016). Thought controlled robotics for motor disabled patients and the case of CSI:Brainwave. 10th Hellenic Spine Congress, Thessaloniki, Greece, 26-29/10/2016 oral presentation (OP6), scientific program book p 8, abstracts cd
  • Kavazidi KR, Athanasiou A, Antoniadis I, Papadopoulou K, Bamidis PD (2016). Application of the Greek Spinal Cord Injury Independence Measure (g-SCIM-III) on Greek patients and correlation with the ASIA scale. 10th Hellenic Spine Congress, Thessaloniki, Greece, 26-29/10/2016 oral presentation (OP8), scientific program book p 9, abstracts cd
  • Athanasiou A, Foroglou N, Kavazidi KR, Klados MA, Bamidis PD (2016). A view on brain connectivity after spinal cord injury. 0th Hellenic Spine Congress, Thessaloniki, Greece, 26-29/10/2016 oral presentation (OP17), scientific program book p 12, abstracts cd

2015

  • Moustakas N, Kartsidis P, Athanasiou A, Astaras A, Bamidis PD (2015). Development of MERCURY version 2.0 robotic arms for rehabilitation applications. In: Proceedings of 8th ACM International Conference on Pervasive Technologies Related to Assistive Environments (PETRA 2015, Corfu, Greece, 1-3/7/2015). ACM, New York, Article 17, 4 pages. ISBN: 978-1-4503-3452-5. https://dx.doi.org/10.1145/2769493.2769558
  • Astaras A, Athanasiou A, Alexandrou A, Kartsidis P, Moustakas N, Bamidis PD (2015). Double-blind greek translation and online implementation of the GODSPEED robotics questionnaire. In: Pallikarakis N, Bamidis PD (eds.) 6th Panhellenic Conference on Biomedical Technology Conference Program & Book of Abstracts, p 34: extended abstract. https://dx.doi.org/10.13140/RG.2.1.1314.9603
  • Athanasiou A, Alexandrou A, Paraskevopoulos E, Foroglou N, Prassas A, Bamidis PD (2015). Towards a Greek adaptation of the Spinal Cord Independence Measure (SCIM). In: Proceedings of 15th European Congress of Neurosurgery (EANS 2014, Prague, Czech Republic 12-17/10/2014), p 181-184. ISBN: 978-88- 7587-716-3. https://dx.doi.org/10.13140/RG.2.1.1669.0087

2014

  • Kartsidis P, Moustakas N, Athanasiou A, Astaras A, Bamidis PD (2014). Comparative analysis of perceived psychometric characteristics: pilot study of the “Mercury” 6-degree of freedom robotic arm. In: Proceedings of 7th Electrical and Computer Engineering Student Conference (ECESCON 7, Thessaloniki, Greece, 11-13/4/2014), p 179-181. https://dx.doi.org/10.13140/2.1.3766.1121
  • Athanasiou A, Foroglou N, Polyzoidis K, Bamidis PD (2014). Graph analysis of sensorimotor cortex functional networks – comparison of alpha vs beta rhythm in motor imagery and execution. In: Gruzelier JH, Arms M, Kenemans JL, Bamidis PD (eds.) SAN/NIHC 2014 Meeting Conference Program & Abstracts, p 64-65. ISBN/EAN: 9789077875810. https://dx.doi.org/10.13140/2.1.3183.3603
  • Moustakas N, Athanasiou A, Kartsidis P, Bamidis PD, Astaras A (2014). Development and user assessment of a body-machine interface for a hybrid-controlled 6-degree of freedom robotic arm (MERCURY). In: Roa Romero LM (ed.) IFMBE Proceedings, 41: 65-68, Spinger International Publishing Switzerland, https://dx.doi.org/10.1007/978-3-319- 00846-2_16
  • Athanasiou A, Moustakas N, Kartsidis P, Astaras A, Bamidis PD (2014). Perceived psychometric characteristics of the «Mercury» prototype robotic arm for rehabilitation applications. 6th International Congress on Brain & Behaviour, Thessaloniki, Greece, 6-8/2/2014 poster presentation (PO.25), program book p 24, abstracts cd. doi: 10.13140/RG.2.1.2142.5689

2013

  • Moustakas N, Athanasiou A, Bamidis PD, Kalfas A, Astaras A, Gogoussis A (2013). A hybrid Brain- and Body-Computer Interface for a 6-degree of freedom robotic arm (Mercury). : Pallikarakis N, Bamidis PD (eds.) 5th Panhellenic Conference on Biomedical Technology Conference Program & Book of Abstracts, p 108: extended abstract. https://dx.doi.org/10.13140/2.1.2652.0002

 

Collaborations

Department of Computing, American College of Thessaloniki

First Neurosurgery department, “AHEPA” University General Hospital

Neurosurgery department, “Papageorgiou” General Hospital, Thessaloniki

 

Media

https://www.youtube.com/watch?v=lqvhHJxuqIM

https://www.youtube.com/watch?v=_B94JrhwuqA

https://www.youtube.com/watch?v=sdPZ0RIYvDk

 

PI & Key personnel CVs

Dr. Panagiotis D. Bamidis is currently Assoc. Prof. in the Lab of Medical Physics, Medical School of the Aristotle University of Thessaloniki, Greece. He has founded and has been leading four research groups, namely, in Medical Education Informatics, in Assistive Technologies and Silver Science, in Applied and Affective Neuroscience, and in Health Services Research. In the last 7 years, he has been the co-ordinator of five large European projects (SmokeFreeBrain.org; www.meducator.net; www.longlastingmemories.eu, www.epblnet.eu, www.childrenhealth.eu) as well as the principal investigator for a number of national and international funded projects. His publication record consists of more than 90 international refereed journal papers, and over 330 international peer reviewed conference papers, as well as several book chapters / edited conference proceedings volumes and over some 1200 citations (h-index>20). In addition, he has been acting as a referee in more than 30 journals, and as Guest Editor in some 25 journal special issues. He is a member of the Editorial Board in 6 journals, Editor in Chief of the Int.Journal of Bioelectromagnetism and Associate Editor in the prestigious series of JMIR journals. He is the President of the Hellenic Biomedical Technology Society (ELEBIT), a member of the Administration Boards of the Society of Applied Neuroscience, the Greek Federation of Alzheimer’s Associations and Related Disorders, the Greek AeroSpace & Space Medicine Research Association, a member of the Life Sciences Division of the International Academy of Astronautics and past member of the Innovation Zone of Thessaloniki, Greece. He is/has been the Chairman/Organiser of nine international conferences (iSHIMR2001, iSHIMR2005, MEDICON2010, GASMA2010, SAN2011, MEI2012, ΜΕΙ2015, SAN2016, CBMS2017) and several national Biomedical Technology conferences. He is the Conference Producer of the Medical Education Informatics Conferences and associated Spring/Summer School Series in Internet Sharing Technologies and Open Data. He is a visiting scientist at Karolinska Institute, Sweden. He is a member of the Advisory Board of the Open Knowledge Foundation and a founding member of Chapter Greece. In 2009, he was awarded the Prize of the AUTH Research Committee for the Best Track Record in funded research projects among AUTH young academic staff. In 2015, he was awarded the title of the Honorary Professor of Karaganda State Medical University, Kazakhstan, as well as the Pospelov Medal for his contributions to Medical Education development by the same University. His research interests are within Affective and Applied Neuroscience, Affective and Physiological Computing, multimodal interaction, BCI and HCI, Health Information Management, Bio-medical Informatics with emphasis on neurophysiological sensing, signal analysis, and imaging of human emotions, technology enhanced learning in Medical Education (web2.0, semantic web and open linked data, serious games, virtual patients, PBL and scenario based learning, learning analytics). He is also actively researching Assistive Technologies for Active and Healthy Ageing and other sensitive societal groups, as well as, special education/developmental disorders, and silvergaming/exergaming/silver-science and the associated use of semantic technologies and IoT. Since 2012 he has established LLM Care ecosystem (www.llmcare.gr), the business exploitation of the LLM project, which is a candidate reference site of the EIP-on-AHA. In 2013 he established the Active and Healthy Ageing Living Lab in Thessaloniki (ThessAHALL; http://www.aha-livinglabs.com/) which in 2016 became an adherent member of the European Network of Living Labs (ENoLL).

Dr. Nicolas Foroglou has graduated from the Medical School of Aristotle University of Thessaloniki. He trained in Neurology in London where he received after 6 months the Diploma of Clinical Neurology from the Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square. Thereafter he returned in Thessaloniki, Greece to complete his residency in Neurosurgery at the AHEPA University Hospital. He traveled to Boston, USA with a scholarship of the Aristotle University for a research fellowship on neuroncology at the Brigham & Women Hospital, affiliated hospital to Harvard Medical School. There he was trained in surgical neuro-oncology and completed some research projects concerning the survival of malignant primary brain tumors, all this under the guidance of Professor P. McLaren Black. He also did a fellowship in Functional Neurosurgery in the University Hospital of Lausanne, Switzerland under the guidance of Professor J.G. Villemure. He was elected as Lecturer of Neurosurgery in the Aristotle University of Thessaloniki in 2002, and as Assistant Professor in 2010, he is currently working at the Department of Neurosurgery, AHEPA University Hospital. He has been cited 178 times in Web of Science, 208 times in SCOPUS, 407 times in Google scholar and his H-Factor is 6. Nicolas Foroglou is active member of many international neurosurgical societies. Currently he is serving as member of the following EANS committees: Individual Member, Post-graduation Education and Research. He is member of the Education Committee of the Hellenic Neurosurgical Society since 2009 and member of the Board of Directors since 2011.

Dr. Alexander Astaras is Asst. Professor in Computer Science at the American College of Thessaloniki (ACT) and a Research Associate in the Lab of Medical Physics, Dept. of Medicine, Aristotle University of Thessaloniki (AUTH), Greece. He obtained his BA in Physics from Oberlin College, Ohio, USA and his PhD in Electronics and Electrical Engineering from the University of Edinburgh, Scotland, UK. He has authored more than 30 publications in the fields of Electronics and Biomedical Engineering (citations >308, H=7), designed and tested 5 prototype electronic ASIC chips and supervised several undergraduate and MSc theses in biomedical engineering and electronics. He is an active member of the IEEE and the Hellenic Biomedical Engineering Society (ELEVIT). In the past he has worked in analogue and mixed-signal integrated circuits, system-on-chip and lab-on-chip integration as well as mapping artificial neural networks on silicon. His research interests include biomedical micro-electro-mechanical data acquisition sensors (bio-MEMS), low power mixed-signal VLSI electronics design, machine learning and medical robotics.

Dr. Aristidis Prassas was born in Goumenissa Kilkis in 1966 and graduated from the School of Medicine in Democritus University of Thrace. He specialized in Neurosurgery in “Papanikolaou” General Hospital in Thessaloniki, Greece. He worked for six months in France in a Spinal Surgery Unit. He has attended numerous seminars and participated in workshops concerning functional neurosurgery, neuroendoscopy and stereotactic biopsies (frame based and frameless) in France, Germany and the Netherlands. He has presented his work in oral presentations in Greek and international Congresses and has published in Greek and international medical journals. His fields of interest and practice are spinal surgery, functional neurosurgery, trauma and neurooncology. He currently work as a Director Consultant Neurosurgeon in “Papageorgiou” General Hospital of Thessaloniki, Greece

Dr. Alkinoos Athanasiou is a board-certified neurosurgeon, individual member of European Association of Neurosurgical Societies (EANS), that recently finished his training at the 1st Department of Neurosurgery, "AHEPA" University General Hospital of AUTH, in Thessaloniki, Greece. He holds clinical experience since 2008 as a scientific associate and resident in clinical departments during his neurosurgical residency training. Having completed an MD in 2008 and an MSc in Medical Informatics in 2012 from School of Medicine, Aristotle University of Thessaloniki (AUTH), he is currently working on his PhD thesis on neuronal circuits of the brain after spinal cord injury, he has published scientific papers in several fields of Neurosurgery and Computational Neuroscience and has presented his work in many medical and scientific congresses, both international and local. Moreover, he has also been involved in peer-reviewer activities, in teaching of several pre-graduate and post-graduate lessons in School of Medicine or lectures during his neurosurgical training and he has participated in organization and technical committees of international scientific congresses. He speaks Greek (native language), English (mastery) and French (working proficiency).